• Mortality among poorly-educated women

    walkerevansThere is an emerging narrative that America is facing a crisis of poorly-educated men. This is a problem we should focus on — so long as we recognize that there is also a crisis among poorly-educated women.

    There are many stories about men falling behind and women stepping up to take their places. A recent and widely-discussed Pew study reported that women are the breadwinners in 40% of US familes. Men suffered greater loss of employment than women in the beginning of the great recession (although this may have evened out later). Moreover, the loss of male employment was concentrated among poorly-educated men. This is particularly troubling, because men are falling behind women in educational attainment:

    Screen Shot 2013-06-02 at 6.00.12 PM

    Economist Michael Greenstone said

    I think the greatest, most astonishing fact that I am aware of in social science right now is that women have been able to hear the labor market screaming out ‘You need more education’ and have been able to respond to that, and men have not, and it’s very, very scary for economists because people should be responding to price signals. And men are not. It’s a fact in need of an explanation.

    Commenting on the Pew Breadwinners data, @Ben_Domenech argued on Twitter that

    Feminine achievement is NOT the problem. Men lagging behind is.

    Considerations like these led Hannah Rosin to write that

    Earlier this year, women became the majority of the workforce for the first time in U.S. history. Most managers are now women too. And for every two men who get a college degree this year, three women will do the same. For years, women’s progress has been cast as a struggle for equality. But what if equality isn’t the end point? What if modern, postindustrial society is simply better suited to women?

    There is nothing wrong and everything right with the increasing success of women in schools and the workplace, and conversely for men who fail in these settings.

    Nevertheless, we should resist reducing the gender narrative about modern America to “women rising / men falling.” That story omits poorly-educated women, who have been experiencing hard times. So hard, in fact, that is it showing up in reduced life expectancy.  Ellen Meara and her colleagues found a decline in the life expectancy of less-educated women in the last two decades of the 20th century.

    Meara

    Similarly, Olshanky and his colleagues found a sharp decline in life expectancy among white women with less than a high school education:

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    Christopher Murray and his colleagues mapped regions of declining female life expectancy in 2011 (dark red):

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    David Kindig and Erika Cheng replicated these findings this spring (worsening female life expectancy in red):

    KindigFigure1

    Jennifer Montez and Anna Zajacova similarly found that the education gap in mortality for white women widened from 1997 to 2006. They also found that high unemployment and high prevalence of unhealthy behaviors were the factors that seemed to explain the decline.

    So why is life expectancy declining among poorly-educated white women when it is increasing among similar minority women? I don’t know and I don’t sense that the researchers in this field know either. I will remark that whereas well-educated white women are pulling away from poorly-educated white women, poorly-educated minority women are catching up. There is every reason to expect that the lack of education, unemployment, and hard persistent poverty harm poorly-educated minority women. However, minority women are still reaping the benefits of increasing access to education and employment resulting from the civil rights revolution, hence the catch-up.

    My point is simple. Women are not pulling ahead. Well-educated women are pulling ahead and more power to them. However, poorly-educated US women are falling behind.

    That life expectancy would decline for a large subpopulation in a developed country in the absence of war or plague is shocking. Steady improvement in life expectancy has been the norm across developed countries since the beginning of the 20th century. Poorly-educated white women may be the canaries in the coal mine of increasing US inequality. Our health and employment policies must give priority to the well-being of poorly-educated members of both genders.

    UPDATE: Over at the Inequalities blog, I comment on the ethical significance of this decline in life expectancy.

    @Bill_Gardner

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    • My question is whether some form of Simpson-Yule effect is at play here. The subgroup “poorly-educated US women” has undergone a dramatic composition change during the last several decades. Healthier, more affluent women are becoming increasingly higher educated. The remaining poorly educated women would have lower life expectancy, not because they are less healthy than previous members of that subgroup, but because the subgroup composition has changed.

    • Bill
      In your companion post, you use “trickle down economics” as a catch all for why women might have fallen behind.

      Given the white vs black divide, outside of opportunities the latter might receive due to social programs–what specifically can you attribute to the delta? You state the authors dont know.

      Can you speculate? Do you really think “catch up” as you state above does the trick? I would think in a dog of an economy and trends over last decade or so, we would see flattening regardless of what advantages one of these groups have over the other.

      Brad

      • Hi Brad,
        I do think ‘catch up’ could be the answer. The opportunities for employment and education for black women have really changed a lot in the last few decades. And some of that benefit is cumulative: a daughter will do better because her mother did better, etc.
        cheers
        Bill

    • I was about to write my own comment, and then read the comment from RC. So I’ll just say, “Ditto.”

    • RC and Sam,
      I think that a change in composition is a possible explanation for why we see a decrease in life expectancy. Jennifer Montez is skeptical, and she knows gobs more than I do about this, so please take a look at her Journal of Health and Social Behavior article.

      For the sake of argument, let’s suppose that the change in composition explains the surprising negative slope for mortality in this subgroup. I don’t think it erases the ethical and policy concern we should feel concerning this large subgroup of women.
      cheers
      Bill

      • Thanks, Bill. I checked out the Montez article, which because of design doesn’t seem to really address it. The key literature here may be Masters et al. “Education differences in US mortality: a cohort perspective.” I don’t have access to the full text, but the abstract has this interesting sentence:

        “Findings reveal that temporal reductions in black and white men’s and women’s mortality rates were driven entirely by cohort changes in mortality.”

        As for ethical and policy concerns, I’ll admit that this is not familiar turf for me. I’m still trying to understand what’s happening.

        • RC’s is the very obvious explanation.

          Considering:

          “Findings reveal that temporal reductions in black and white men’s and women’s mortality rates were driven entirely by cohort changes in mortality.”

          Ellen Meara and her colleagues work is a case of yellow journalism statistics.

          Further ff it turned that it is not purely a compositional change then it would more likely be more access to drugs including booze and food due to a to rich welfare system. There was no decline in access to food clothing or shelter in the USA between 1981 and 1998 where the first chart shows a decline.

    • Looking at a map on the increase in obesity I noted that there seems to be an overlap between obesity and declining mortality for poor women.

      This suggests more work on policy aimed at controlling the food industry’s calorie-pushing and making it easier to walk or bike to places would help, perhaps more than getting those poor women to see doctors more often, as Ashish Jha pointed out that insurance and access doesn’t lead to a significant improvement in control of diabetes. (poor control 46% in the uninsured, 44% in the insured group).

      (http://www.hsph.harvard.edu/obesity-prevention-source/us-obesity-trends-map/)

      My policy of choice is working to ensure a safe path to walk or bike to school for all children. This means real bike paths, not just paint on a busy road. Crossings that don’t require dodging traffic.

      I’ve noted that Maine’s obesity is rising. Increasingly, there are housing developments in places where you can’t get out of the development on foot, without crossing or going on the side of a highway. Once, all those rural Mainers farmed and got plenty of exercise. Now they don’t.

    • @SAO
      But obesity rates are rising for all groups regionally and SES wise:

      Between 1988–1994 and 2007–2008 the prevalence of obesity increased in adults at all income and education levels.

      And we are looking at changes here so even if some areas are fatter as long as the relationship did not change it does not explain what we are looking at.

    • One more point today very few girls fail to finish high school today fewer that in 1981. One reason to not finish high school today is severe illness or death, another reason is severe drug addiction.